3-in-4 current fentanyl users started with prescription opioids

~ Jason Schwartz

For years, many experts have “well, actually-ed”, arguing that prescribing patterns had little to do with the opioid crisis. Of course, the opioid crisis is a complex and wicked problem, but we are poorly served by experts who scold the public and tell us not to believe our lying eyes.

JAMA Health Forum provides some commentary on recently published information suggesting that recent reports dramatically underreported opioid use.

In this issue of JAMA Health Forum, Powell and Jacobson found that the past-year prevalence of the use of illicitly manufactured fentanyl (IMF) reported in a June 2024 online survey of individuals 18 years and older was 7.5% (95% CI, 6.2%-8.9%). They note that this number is vastly higher than the 0.3% estimate reported in the 2022 National Survey on Drug Use and Health (NSDUH). IMF prevalence did not jump 20- or 30-fold between 2022 and 2024; indeed, point estimates from the 2023 NSDUH are lower than in 2022.

It is also important to note that Powell and Jacobson found that even as late as 2024, it remains the case that 3-in-4 current consumers of IMF started their nonmedical opioid use with prescription opioids. This is an important reminder that the present crisis is not only an IMF epidemic. Most of those dying with IMF in their system started down the path that led to their death by misusing prescription painkillers. We should not absolve prescription opioids from responsibility for those deaths just because they were not present in the body at death. Doing so would be like saying that cigarettes did not cause the death of a lifelong smoker who succumbed to lung cancer after they quit smoking.

Caulkins JP, Midgette G, Reuter P. Improving Opioid Use Estimates Through Multiple Data Sources. JAMA Health Forum. 2025;6(5):e250806. doi:10.1001/jamahealthforum.2025.0806

Take the time to read the whole thing here.

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Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I currently serve as the Director of Social Work and Spiritual Care for a healthcare system. I've also served as the Director of Behavioral Health at another hospital. I'm also a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.

One thought on “3-in-4 current fentanyl users started with prescription opioids”

  1. Great review! I have had conversations with lots of young folks seeking recovery who told me the addiction process often began with cigarettes, alcohol and marijuana. Followed by their parents prescription drugs which are costly. Followed by heroin laced with Fentanyl. In essence, the addiction process often begins before the opioid use. When counselors don’t explore and address the early drugs clients are more vulnerable to return to those drugs followed by the opioids. Mark Mark Sanders

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